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20.04.2020 | Gastrointestinal Oncology

Appropriate Candidates for Salvage Esophagectomy of Initially Unresectable Locally Advanced T4 Esophageal Squamous Cell Carcinoma

verfasst von: Eisuke Booka, MD, PhD, Ryoma Haneda, MD, Kenjiro Ishii, MD, PhD, Takeshi Kawakami, MD, Takahiro Tsushima, MD, Hirofumi Yasui, MD, Tsuyoshi Onoe, MD, Hirofumi Ogawa, MD, Yasuhiro Tsubosa, MD, PhD

Erschienen in: Annals of Surgical Oncology | Ausgabe 9/2020

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Abstract

Background

Standard treatment for unresectable locally advanced esophageal cancer is definitive chemoradiotherapy (dCRT). Although salvage esophagectomy is the only curative treatment available following dCRT failure, the appropriate candidates for salvage esophagectomy remain unclear.

Patients and Methods

Three hundred seventeen patients who underwent dCRT from April 2004 to December 2016 were stratified into three study groups—a complete response (CR) group, chemotherapy or best supportive care (BSC) group, and salvage esophagectomy group—and compared. We also investigated the clinical outcomes and prognostic factors of salvage esophagectomy.

Results

Seventy-one patients (22.4%) achieved CR after dCRT, 18 patients (5.7%) underwent salvage esophagectomy, and 228 patients (71.9%) underwent palliative chemotherapy or BSC. The 5-year overall survival (OS) rates of the CR group, salvage esophagectomy group, and chemotherapy or BSC group were 83.0%, 51.6%, and 1.3%, respectively. Salvage esophagectomy recipients had a worse OS rate than CR patients (p < 0.001) but a better OS rate than those in the chemotherapy or BSC group (p < 0.001). Incomplete resection was the only significant variable associated with poor OS on univariate Cox proportional-hazards analysis (hazard ratio: 7.633, 95% confidence interval: 1.692–34.482; p = 0.008). Patients with tumors in the upper thoracic esophagus were more likely to undergo incomplete resection (p = 0.011).

Conclusions

Patients who achieve R0 resection are good candidates for salvage esophagectomy regardless of their response to dCRT. Those with upper thoracic esophageal tumors are at risk of incomplete resection; careful attention is required when considering these patients for salvage esophagectomy.
Literatur
1.
Zurück zum Zitat Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65:87–108.CrossRef Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65:87–108.CrossRef
2.
Zurück zum Zitat Ando N, Ozawa S, Kitagawa Y, Shinozawa Y, Kitajima M. Improvement in the results of surgical treatment of advanced squamous esophageal carcinoma during 15 consecutive years. Ann Surg. 2000;232:225–32.CrossRef Ando N, Ozawa S, Kitagawa Y, Shinozawa Y, Kitajima M. Improvement in the results of surgical treatment of advanced squamous esophageal carcinoma during 15 consecutive years. Ann Surg. 2000;232:225–32.CrossRef
3.
Zurück zum Zitat Kawakami T, Tsushima T, Omae K, et al. Risk factors for esophageal fistula in thoracic esophageal squamous cell carcinoma invading adjacent organs treated with definitive chemoradiotherapy: a monocentric case-control study. BMC Cancer. 2018;18:573.CrossRef Kawakami T, Tsushima T, Omae K, et al. Risk factors for esophageal fistula in thoracic esophageal squamous cell carcinoma invading adjacent organs treated with definitive chemoradiotherapy: a monocentric case-control study. BMC Cancer. 2018;18:573.CrossRef
4.
Zurück zum Zitat Ohtsu A, Boku N, Muro K, et al. Definitive chemoradiotherapy for T4 and/or M1 lymph node squamous cell carcinoma of the esophagus. J Clin Oncol. 1999;17:2915–21.CrossRef Ohtsu A, Boku N, Muro K, et al. Definitive chemoradiotherapy for T4 and/or M1 lymph node squamous cell carcinoma of the esophagus. J Clin Oncol. 1999;17:2915–21.CrossRef
6.
Zurück zum Zitat Kitagawa Y, Uno T, Oyama T, et al. Esophageal cancer practice guidelines 2017 edited by the Japan esophageal society: part 1. Esophagus. 2019;16:1–24.CrossRef Kitagawa Y, Uno T, Oyama T, et al. Esophageal cancer practice guidelines 2017 edited by the Japan esophageal society: part 1. Esophagus. 2019;16:1–24.CrossRef
7.
Zurück zum Zitat Kitagawa Y, Uno T, Oyama T, et al. Esophageal cancer practice guidelines 2017 edited by the Japan Esophageal Society: part 2. Esophagus. 2019;16:25–43.CrossRef Kitagawa Y, Uno T, Oyama T, et al. Esophageal cancer practice guidelines 2017 edited by the Japan Esophageal Society: part 2. Esophagus. 2019;16:25–43.CrossRef
8.
Zurück zum Zitat Brierley JD, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumors: International Union against Cancer. 8th ed. Oxford: Wiley; 2017. Brierley JD, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumors: International Union against Cancer. 8th ed. Oxford: Wiley; 2017.
9.
Zurück zum Zitat Shinoda M, Ando N, Kato K, et al. Randomized study of low-dose versus standard-dose chemoradiotherapy for unresectable esophageal squamous cell carcinoma (JCOG0303). Cancer Sci. 2015;106:407–12.CrossRef Shinoda M, Ando N, Kato K, et al. Randomized study of low-dose versus standard-dose chemoradiotherapy for unresectable esophageal squamous cell carcinoma (JCOG0303). Cancer Sci. 2015;106:407–12.CrossRef
10.
Zurück zum Zitat Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. J Natl Cancer Inst. 2000;92:205–16.CrossRef Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. J Natl Cancer Inst. 2000;92:205–16.CrossRef
11.
Zurück zum Zitat Eisenhauer E, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–47.CrossRef Eisenhauer E, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–47.CrossRef
12.
Zurück zum Zitat Japan Esophageal Society. Japanese classification of esophageal cancer, 11th ed. Part II and III. Esophagus. 2017;14:37–65.CrossRef Japan Esophageal Society. Japanese classification of esophageal cancer, 11th ed. Part II and III. Esophagus. 2017;14:37–65.CrossRef
13.
Zurück zum Zitat Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.CrossRef Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.CrossRef
14.
Zurück zum Zitat Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRef Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRef
15.
Zurück zum Zitat Tachimori Y, Kanamori N, Uemura N, Hokamura N, Igaki H, Kato H. Salvage esophagectomy after high-dose chemoradiotherapy for esophageal squamous cell carcinoma. J Thorac Cardiovasc Surg. 2009;137:49–54.CrossRef Tachimori Y, Kanamori N, Uemura N, Hokamura N, Igaki H, Kato H. Salvage esophagectomy after high-dose chemoradiotherapy for esophageal squamous cell carcinoma. J Thorac Cardiovasc Surg. 2009;137:49–54.CrossRef
16.
Zurück zum Zitat Watanabe M, Mine S, Nishida K, et al. Salvage esophagectomy after definitive chemoradiotherapy for patients with esophageal squamous cell carcinoma: Who really benefits from this high-risk surgery? Ann Surg Oncol. 2015;22:4438–44.CrossRef Watanabe M, Mine S, Nishida K, et al. Salvage esophagectomy after definitive chemoradiotherapy for patients with esophageal squamous cell carcinoma: Who really benefits from this high-risk surgery? Ann Surg Oncol. 2015;22:4438–44.CrossRef
17.
Zurück zum Zitat de Manzoni G, Pedrazzani C, Pasini F, et al. Chemoradiotherapy followed by surgery for squamous cell carcinoma of the thoracic esophagus with clinical evidence of adjacent organ invasion. J Surg Oncol. 2007;95:261–6.CrossRef de Manzoni G, Pedrazzani C, Pasini F, et al. Chemoradiotherapy followed by surgery for squamous cell carcinoma of the thoracic esophagus with clinical evidence of adjacent organ invasion. J Surg Oncol. 2007;95:261–6.CrossRef
18.
Zurück zum Zitat Ikeda K, Ishida K, Sato N, et al. Chemoradiotherapy followed by surgery for thoracic esophageal cancer potentially or actually involving adjacent organs. Dis Esophagus. 2001;14:197–201.CrossRef Ikeda K, Ishida K, Sato N, et al. Chemoradiotherapy followed by surgery for thoracic esophageal cancer potentially or actually involving adjacent organs. Dis Esophagus. 2001;14:197–201.CrossRef
19.
Zurück zum Zitat Ohkura Y, Ueno M, Iizuka T, Udagawa H. Prognostic factors and appropriate lymph node dissection in salvage esophagectomy for locally advanced T4 esophageal cancer. Ann Surg Oncol. 2019;26:209–16.CrossRef Ohkura Y, Ueno M, Iizuka T, Udagawa H. Prognostic factors and appropriate lymph node dissection in salvage esophagectomy for locally advanced T4 esophageal cancer. Ann Surg Oncol. 2019;26:209–16.CrossRef
20.
Zurück zum Zitat Booka E, Takeuchi H, Nishi T, et al. The impact of postoperative complications on survivals after esophagectomy for esophageal cancer. Medicine. 2015;94:e1369.CrossRef Booka E, Takeuchi H, Nishi T, et al. The impact of postoperative complications on survivals after esophagectomy for esophageal cancer. Medicine. 2015;94:e1369.CrossRef
21.
Zurück zum Zitat Booka E, Takeuchi H, Suda K, et al. Meta-analysis of the impact of postoperative complications on survival after oesophagectomy for cancer. BJS Open. 2018;2:276–84.CrossRef Booka E, Takeuchi H, Suda K, et al. Meta-analysis of the impact of postoperative complications on survival after oesophagectomy for cancer. BJS Open. 2018;2:276–84.CrossRef
Metadaten
Titel
Appropriate Candidates for Salvage Esophagectomy of Initially Unresectable Locally Advanced T4 Esophageal Squamous Cell Carcinoma
verfasst von
Eisuke Booka, MD, PhD
Ryoma Haneda, MD
Kenjiro Ishii, MD, PhD
Takeshi Kawakami, MD
Takahiro Tsushima, MD
Hirofumi Yasui, MD
Tsuyoshi Onoe, MD
Hirofumi Ogawa, MD
Yasuhiro Tsubosa, MD, PhD
Publikationsdatum
20.04.2020
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 9/2020
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-020-08440-7

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